Become Great At Knot Tying

Several months back during my surgery rotation, my preceptor and chief resident (Dr. Smith*) gave me some great advice becoming better at surgical knot tying so I thought I would share.

• Learn the square knot and be able to tie it by perfectly and quickly (by hand and instrument). There are lots of surgical knots to learn, but the square knot will get you through most situations. 

• Practice tying everyday. You often see medical students/residents walking around with string hanging from the tie their scrub pants or to a loop in their white coat.... this is because they are practicing tying in their down time. I started doing it and it is amazing how much practice you can get during the day - on the elevator, during rounds, on the T on the way to work. Dr. Smith said he still practices tying 100s of knots a day and he has been doing so since his first day of residency four years ago.

• Make it second nature. When you first start you will need to look at the string/thread and concentrate... however the goal is to be able to tie and tie well while doing something else. Dr. Smith recommended practicing knot tying during your favorite show at home while sitting on the couch. If you don't have scrubs on - place a coffee mug between your knees and use the handle of the mug as an anchor. 

• Materials. Since suture packs are expensive and I doubt the hospital would appreciate you snagging a bunch of $4-5 brand new suture packs to *practice* tying - there are other options. 1) after each of your OR cases, ask the scrub nurse if there are any opened, unused sutures left that you could have to practice with - if not, they get thrown away and 2) go to a sporting goods store and buy your own. Fishing line (mono filament and braided) are remarkably similar to suture material and you can buy 1800 yds of mono filament line for about $8 and 100 yds of braided for about $6.

This is the brand of braided line that I use. It is similar to "string ties". Purchased it at Dick's Sporting Goods for $6.

Using the arm of a mug as an anchor works great if you don't have scrubs on.

*Dr. Smith is a fictional name.